Keep it up

    31 May 2014

    ‘Er… I’ve got a touch of Ascension Deficit Disorder,’ said the patient in our consulting room.Over the years, we’ve heard every euphemism for potency problems: ‘insufficient lead in the pencil’, ‘wonky hydraulics’ or even ‘a touch of the Flaccido Domingos’.

    In fact, these days patients don’t actually have to say the awkward word ‘impotence’. Some years ago it was decided that it would be less upsetting for men if the name was changed to ‘erectile dysfunction’ — ‘ED’. Therefore, if you’re a man who is finding it tricky to get his phallus in a stiff enough condition for action, all you have to do is to tell your GP that you’ve got ‘ED’. He or she will understand.

    After all, your GP has many patients who are troubled by this difficulty. According to some estimates, 40 per cent of men over 40 have ED. This alarming statistic appears to originate with companies who make erection-inducing drugs — the figures gathered in Alfred Kinsey’s pioneering research were rather lower.

    ED can happen for many reasons. In young men it’s often due simply to nerves. In middle-aged ones, it is frequently caused by bereavement, divorce or financial problems. But in the over-45s the biggest factor is that the blood vessels — i.e. the tubes that supply blood to the penis — aren’t in as good a condition as they once were. They’ve lost some of their ability to expand, so they’re not so effective in delivering blood. Since an erection is a penis filled drum-tight with blood, this creates difficulty in getting a ‘hard on’. Here’s why Viagra works so well. It opens up the vessels which supply blood to the penis, and — bang! — you have an erection.

    Over the past 16 years the Viagra-like group of drugs (officially termed ‘the PDE5 inhibitors’) have restored the flagging sex lives of millions of men. They include Viagra itself, Levitra, Cialis (which has the advantage of a longer period of action), and the newly introduced Stendra (avanafil).

    Other pharmacological agents include alprostadil, a drug which induces almost immediate erection. It can be given in two ways. A man can drop a pellet into the opening at the tip of his penis. Or he can inject himself, sticking the needle into the side of his organ — definitely not for the faint-hearted.

    There are also devices called ‘vacuum pumps’ which ‘suck’ the flaccid organ until it becomes stiff. This tends to give you a rather blue (and cold) erection.

    You may be surprised that we haven’t so far mentioned lack of male hormone as a cause of ED. This deficiency can occur, but it is nowhere near as common as people imagine. However, there is a whole area of private medicine which is devoted to persuading men that they need regular doses of the male hormone testosterone. Sometimes this works and sometimes it doesn’t.

    Finally, there are surgical procedures in which an inflatable ‘splint’ is inserted into the penis. Make sure you choose a highly experienced surgeon!

    Whatever you decide to do about the problem, please appreciate the effect that your ED (and its treatment) may have on your partner. It’s always wise to discuss your situation with whoever shares your bed. Fortunately, most are kind and supportive about ED, and are often relieved to find that it’s a medical problem and not a loss of interest in them. Also, it’s important for any partner to understand that if a male is taking an anti-ED drug, it’s not his fault that he has to wait an hour or so for the pill to take effect. While you’re waiting, you can always have a cup of tea.

    If your man is hell-bent on restoring his potency, do dissuade him from purchasing anti-ED drugs off the internet. He can’t be sure what he’s really buying, and may not only waste money but also do himself harm.